[stok191]

Do these test results indicate I have myeloma?

by stok191 on Thu Sep 19, 2013 12:42 pm

I'm a 33 year old male. I have been to several doctors recently for health issues. My symptoms are pain in the pelvic bones, SI joint pain, intermittent lower back pain and pain in hands and feet. I have had a full blood workup, imaging - xrays of lower spine, pelvis and mri of l-spine. Nothing abnormal has be noted.

The latest doctor did perform a SPEP w/immunofixation and a 24 hr UPEP w/ immunofixation. The SPEP was normal with no monoclonal patterns detected. The 24 hr urine was as below:

creatinine, 24 hour =13.89 ref range .63-2.50 g
protein/creatinine ratio = 25 ref range < or = 84 mg/g
protein, total, 24 hour =353 ref range < 150 mg/24

The immunofixation revealed no monoclonal pattern detected.

My doctor said the the following test results were "normal". I questioned him on the elevated protein and he said it was due to the volume of urine I collected over 24 hrs. I am the one concerned about multiple myeloma. My doctor is not but ran the test because I asked him to.

I was hoping to get some advice to rule out multiple myeloma. I have gotten some good advice from one forum member through PM. But would like some others thoughts.

Thanks

[Dr. Jason Valent]

Re: Do these test results indicate I have myeloma?

by Dr. Jason Valent on Sun Sep 22, 2013 2:37 pm

Negative urine and serum immunofixation and imaging without lytic lesions makes myeloma very unlikely.

[stok191]

Re: Do these test results indicate I have myeloma?

by stok191 on Wed Sep 25, 2013 11:32 am

Thank you Dr. Valent for your insight. Is there any reason to pursue a serum FLC test? Thanks again

[stok191]

Re: Do these test results indicate I have myeloma?

by stok191 on Sat Jun 14, 2014 5:08 am

I wanted to followup this question with some additional information. My symptoms are still present. So I asked my doctor to perform a serum FLC test. The results are below. I presume this is not good.

Kappa 201 mg/dl, lambda 81 mg/dl, and ratio 2.5.

Both the kappa and lambda and ratio are elevated. They also ran SPEP and UPEP which came back normal. The SPEP had a low value on the alpha 2 globuins.

My doctor's office is closed. I got the results online. Any suggestions ... I have been worried about health for the past year because of odd symptoms. Any thoughts would be appreciated. Thanks.

[Dr. Prashant Kapoor]

Re: Do these test results indicate I have myeloma?

by Dr. Prashant Kapoor on Sun Jun 15, 2014 8:43 am

In your case it appears that the kappa/lambda ratio as well as both free light chains are elevated somewhat. This is a borderline result, and should be considered in its clinical context since such results can be seen in a variety of disorders, including kidney impairment, polyclonal gammopathy related to infections, rheumatic/autoimmune disorders and diabetes mellitus as well as monoclonal diseases such as myeloma, AL amyloidosis, lymphomas, light chain monoclonal gammopathy, light chain deposition disease, etc. Please talk to your physician who could run tests to rule out these conditions.

The free light chain levels and ratio should be monitored periodically.

[stok191]

Re: Do these test results indicate I have myeloma?

by stok191 on Tue Jun 17, 2014 11:53 am

Dr. Kapoor,

Thank you for your response. After carefully reviewing the results I realized that the physician ordered the wrong light chain test. They ordered the kappa/lambda light chain, total test instead of the free light chain only test. So I was actually in the normal reference range for all three results.:

Reference range

Kappa 74-295 mg/dL
Lambda 32-156 mg/dL
Kappa/Lambda Ratio 1.3-2.7

Should I have a free light chain only assay performed to help rule out something serious because of my symptoms?

I appreciate your suggestions, Dr. Kapoor, and want to thank you for your wonderful contribution to this board.